LIBRARY OF CONGRESS 



021 064 023 A 



Hollinger Corp. 
P H8.5 






1905 



BT 



SAMUEL D. RISLEY, M. D. 



AND 



ROLAND G. CURTIN, M. D. 

PHILADELPHIA 



Reprinted from the 

Transactions of the American Cljmatologicai, 

Association, 1905 



Gift 
Aufckoi* 
(ferson) 




Isthmus of 

Panama. 









CONDITIONS IN PANAMA— REPORT OF DELEGATES 

TO THE FOURTH PAN-AMERICAN MEDICAL 

CONGRESS, AT PANAMA. 

BY S. D. RISLEY AND DR. R. G. CURTIN, 

OF PHILADELPHIA. 



Gentlemen : Your Delegates to. the Pan-American Medical 
Congress at Panama beg leave to present the following report of 
their personal experiences, observations and reflections. They 
found it no simple undertaking to travel southward 2,000 miles 
on a line dropped from a point on the Atlantic Coast, near the 
center of the North Temperate Zone, starting in the midst of a 
frigid winter, to encounter at the end of the journey the humid, 
high temperatures of the tropics ; a fact which opens the question 
v as to the wisdom of assembling a congress so near the Equator. 

Leaving Philadelphia in 39 ° north latitude on December 26th, 
we reached Colon, the Atlantic Port of the Isthmus of Panama, 
in 9 north latitude, on January 2nd. 

The route chosen was by rail to New Orleans, thence to Colon 
by the S. S. Beverly, a United Fruit Co. steamer which had been 
chartered and provisioned to carry the delegates from the United 
States to the Congress. 

On our arrival at New Orleans we found the following pleas- 
ant company of physicians, several of whom were accompanied by 
their wives, assembled on the ship, but shivering in a temperature 
at the freezing point : Dr. Nicholas Senn of Chicago. Dr. L. Waite 
of Chicago, Dr. H. P. Newman of Chicago, Dr. Hale of Chicago, 
Dr. D. R. Brower and wife, Dr. C. Wilbur Wheeler, Dr. Palmer 
and wife, Dr. P. C. Coleman of Texas, Dr. Knox Bacon and wife 
of St. Paul,. Dr. Hughes, St. Louis, Dr. Crill and wife, Dr. Emilio 
Martinez of Havana, Cuba; Dr. Isadore Dyer and Dr. Chassig- 
nac of New Orleans. At 1.30 p. m. on December 28th the jour- 
ney down the noble Mississippi was begun, reaching the Delta 
after sunset. The trip down the river was enlivened bv a race 
between the Beverly and a steamer bound for New York which, 




This hospital i 



ANCON HOSPITAL AND THE CAPITAL OF THE CANAL ZONE 
ered one of the finest in the world, both < 
and efficient corps of physieit 






2 S. D. RISLEY AND DR. R. G. CURTIN 

proved interesting" not only from the fact that we won in the 
contest of speed, but in that it proved that the racing spirit of 
early river days was not entirely a thing of the past. From the 
Delta of the Mississippi the route carried us across the Gulf of 
Mexico, through the Straits of Yucatan and over the blue Carib- 
bean Sea. The sail on these waters proved an interesting expe- 
rience to every voyager not afflicted by seasickness, and could but 
stir the imagination as one recalled the strangely interesting 
history of the adventurous souls who first navigated them, and 
whose audacious valor, outrageous cruelty and greed spread a veil 
of romance, not alone over their own lives but over the lands they 
discovered and which have been dominated by them and their 
descendants for several centuries. 

As the ship pursued her southward way, she was soon in the 
embrace of the perpetual trade winds, and was rocked in the 
trough of the sea with a pertinacity most disturbing to the comfort 
of landsmen who essay to "go down to the sea in ships." If the 
traveller left his berth sufficiently early to face the rising 
sun, as he stood upon the port beam of the ship, it required no 
stretch of the imagination to realize that he remained, held by 
gravity alone, upon the surface of the eastward rolling globe and 
was breasting, in the easterly wind, the friction and resistance of 
the enveloping atmosphere and shuddered lest gravity should 
release its hold upon him and he be left behind, suspended in 
planatory space. 

The absence of the usual evidences of life in the sea was- 
noteworthy. With the exception of numerous flying fish, many 
of which landed upon the deck during the night, a few sea gulls 
and the beautiful and delicate nautilus no other living thing was 
seen. 

The very numerous examples of the mythical, dainty nautilus, 
with their diaphanous sails glinting with varied colors in the 
sunshine as they floated restlessly and buoyantly on the surface 
of the water, seemed the unlaid ghosts of the bold and adventur- 
ous Buccaneers, who sailed westward on the wings of the 
East Wind never to return. 

The dawn of the fourth day found our ship at anchor in the 
bay of Colon. As the sun rose we had our first view of the 
Isthmus of Panama with its spine of undulating, verdure covered 
hills swathed in a blue-gray veil of mist, which softened their 
outlines, and screened them in mystery. This impression was 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 3 

emphasized by the rising of the sun, apparently in the south. 
Turning to the atlas it will be seen that the trend of the isthmus 
is from east to west, while that of the two great continents which 
it both separates and connects is from north to south ; that North 
and South America lie upon the water like a pair of huge saddle 
bags with the isthmus as their nexus. It is as though the 
Almighty, Maker of continents, careering through space on 
winged steed, had flung from his saddle bow, upon the bosom of 
the sea, a north land and a south, with all their treasure of gold 
and silver and more precious things, but failed, — or was it by 




A Wharf at Colon. 



design? — to tear them asunder, and so they remain to arrest the 
billowing tides, and to turn back, deflecting to the north and the 
south, the rivers of the Equator to warm the cold shores bathed 
by currents from polar seas. Why were the continents not torn 
apart and left, the one under the influence of the constellations 
of the Great Bear, and Orion with his club, the other under the 
mysterious power of the brilliant Southern Cross? Who can tell 
what would have been the course of the political history of man- 
kind or the physical geography of the continents had the creative 
finger creased a pathway for the waters between the Atlantic and 
Pacific? 



4 S. D. RISLEY AND DR. R. G. CURTIN 

After official inspection by Dr. Perry of the U. S. Marine 
Hospital Service, to whom we are indebted for many courtesies, 
we were landed in small boats. At the wharf we were received 
by the President, Dr. Julio Icaza, and other officers of the Con- 
gress, all of whom met and welcomed the arriving members with 
the delightfully effusive courtesy so characteristic of the Latin 




View of the Harbor and part of the city of Panama, from the 
balcony of the President's Palace. 

races. The introductions over, we were escorted to the Washing- 
ton Hotel, which is delightfully situated on the shore of the 
Bay of Colon below the major part of the city, embowered in a 
grove of cocoanut palms and many other varieties of tropical 
trees, tinted foliage shrubs and brilliant flowering plants, where 
we partook at 1 1 o'clock of the conventional Panama breakfast. 

We were then supplied with transportation to Panama City 
where we arrived at 4.30 p. m. and were met at the station by 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 




A typical street in Panama City. 



6 



S. D. RISLEY AND DR. R. G. CURTIN 



Col. Gorgas of the U. S. Army, the efficient and gentlemanly 
head of the sanitary department of the Canal Zone ; Dr. Carter 
of the Marine Hospital Service, Dr. La Garde, U. S. A., and 
many others interested in the entertainment and scientific work 
of the Congress. 

Accommodations were secured at the Grand Central Hotel, 
a quaint old structure of the Spanish-American type of architec- 
ture. It stands facing the open cathedral plaza which is richly 
crowded with tropical foliage and beyond which, partially con- 




De Lesseps' Buildings back of Colon. 



cealed by royal palms, could be seen rising the twin yellow stone 
towers of the ancient Cathedral. The brief delay at Colon, the 
journey of forty-five miles by the famous Panama R. R., which 
had consumed four hours ; the turmoil and contention, after the 
Spanish fashion, in getting quarters at the hotel; the meeting 
of friends who had arrived earlier, etc., were all replete with in- 
terest and novelty which left a confusing mental picture requiring 
many days of careful observation to dispel and classify. The 
hot, humid climate, the motly population, composed of Jamaican 
negroes, Carib Indians, Japanese, Chinese, Spanish-Americans 
of widely differing degree in the social scale, Europeans and the 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 7 

recent acquisitions from the United States, not only as govern- 
mental employees but those who were loitering about keenly 
studying the changing conditions on the Isthmus with an eye 
to business ventures. 

The strange and squalid dwellings in Colon and along the 
railroad, many of them mere shacks reared on piles and covered 
with dried grass or palm leaves ; the rank vegetation ; the morass 
over which the train sped for the first nine miles of the journey; 
the profusion and endless variety of trees and shrubs, all un- 
familiar to the dweller in the temperate zone ; the known and 




Suburbs of Colon 



unknown varieties of fruits and flowers which hemmed in the 
roadbed on either side ; the glimpses now and again of the exca- 
vations for the canal and of the immense collections of abandoned 
French machinery : — locomotives, cars, dredges and hoisting 
engines, derricks and boats ; all rusting and rotting in the moist 
heat but partially, we thought mercifully, concealed by the rank 
growth of vegetation which enveloped them ; here and there 
picturesque views of the famous but dreaded Chagres River. 
Many congregations of vultures were seen, nature's black, silent, 
and solemn scavengers. Occasionally birds of brighter plumage 
were discovered darting away under the glint of the sunshine 



8 



S. P. RISLEY AND DR. R. G. CURTIN 



and disappearing into the impenetrable mazes of the forest jungle. 
Stepping from the train at some of the numerous stations 
parrots, gorgeous peacocks, and monkeys, held in bondage and 
for sale, were seen. The latter, especially, seemed strangely in 
harmony with a stranger's impressions of a strange environment. 




The Esplanade on the old sea wall looking out upon the bay. 



These simians with their pleading eyes and manifest fear; with 
their chattering but wordless mouths, and their wise appearing 
human visage, suggested to us a human soul in bondage to some 
strange spell of enchantment, but looking in vain for deliverance. 
The flowers we plucked were not fragrant, we heard no pleasing 
note of bird music. "It is a land of odorless flowers and songless 
birds !" 



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CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 9 

Nevertheless, Dr. Nelson says : "A careless or unobservant traveller, 
writing on the tropics, has said : 'The birds are without song and the 
flowers without odor.' If ever there were a gratuitous libel it is this. The 
flowers within the tropics are noted for their wonderful fragrance, and it 
may not be known that even the orchid family, which furnishes the most 
wonderful of flowers, at night exhales delightful perfume. It is quite 
true that during the day these plants are devoid of it. As to the second 
allegation, that the birds are without song, I must say that that good 
man probably saw no other bird except the turkey buzzard." 



We failed to discover the beautiful songs and fragrant odor 
described by Dr. Nelson, in all probability because we were en- 
gaged in the sessions and functions of the Pan-American Medical 
Congress in the evenings and were surrounded by other odors 
which were more penetrating, and the song birds perhaps do not 
do their singing in the month of January, or, the meeting of the 
Medical Congress may have had a depressing effect upon the 
birds. 

The sole relief from the strangely depressing influence of our 
first experiences was affored by witnessing the numerous groups 
of khaki-clad canal engineers, active, strong, busily engaged in 
surveying and draining the roadbed and cleaning a space on either 
side of the track from the rapidly growing vegetation. To merely 
look at them was as refreshing as a cool breeze at the close of a 
sultry summer day. Placed beside them the indolent, shiftless 
natives, white, yellow, or black, seemed a sad and sickly crew and 
made us feel proud of Americans in general. 

The first night at the hotel at Panama served only to empha- 
size the depressing impressions of the journey thither. Pasted on 
the walls in the corridors, bedrooms and in every available space 
were placards from the sanitary corps advising of the necessity 
for sleeping under mosquito bars and of taking quinine daily. 
Before an hour had passed a gentleman advised us not to put our 
shoes on in the morning until they had been shaken to dislodge 
possible tarantulas and scorpions. The relative futility of the 
advice regarding the mosquito bars soon became apparent as the 
brief twilight of the tropics sank almost suddenly into night. 
As soon as the electric lights were turned on herds of mosquitoes 
filled the hotel through the unscreened doors and windows. One 
of the first items of news that came to us after our arrival was 
the sad death from yellow fever of Mrs. Seger, which had oc- 



10 



S. D. RISLEY AND DR. R. G. CURTIN 



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CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 11 

curred but an hour before. She was the young and accomplished 
wife of Genl. Davis' private secretary, who, as a bride, had come 
from New York to the Isthmus in November. The American 
colony were almost panic stricken over the occurrence, which 
seemed to confirm the wild stories we had heard, while still on 
shipboard, of the prevalence of yellow fever at Panama City. The 
following morning, on awakening, one of us discovered that he 
had been bitten and found a stegomya, well gorged, clinging to 
the inner side of the mosquito bar under which we had slept; a 
discovery not calculated to give added joy during the following 
five days, the incubation period for the fell disease. We found 
the meshes of the mosquito netting large enough to admit a 
full grown insect. 

The experiences of the first day and night on the Isthmus 
form a depressing mental picture, difficult to portray in words, 
for it was a new, first glimpse, of human life in the tropics under 
altogether peculiar geographic and climatic conditions. The 
days which followed were, for your delegates, an opportunity 
to study these conditions and they have sought to unravel and 
explain them in their relation of cause and effect in the following 
detailed report. 

That the conditions which have obtained on the Isthmus of 
Panama and the contiguous portions of Central America for 
several centuries are depressing cannot be truthfully denied. It 
is our design to show the relation which the social structure, as 
it has existed there, bears to the climatic conditions, and how far 
these relations can be modified and improved by a wise scientific 
application of sanitary measures, to the problems which are pre- 
sented for solution. 

Any adequate study of the climatology of the Isthmus involves 
primarily a consideration of the geography, topography and 
geology of that portion of Central America. The Republic of 
Panama is situated between approximately jy 2 ° and 9^3° of 
north latitude, the canal zone lying about 600 miles north of 
the Equator. While the general trend of the isthmus is from 
east to west, it lies like a bent bow, with its convexity to the 
north bathed by the Caribbean Sea, while the Bay of Panama lies 
in its concavity on the south. It joins Columbia on the east 
and Costa Rico on the west. The population of the Isthmus is 
311,000 and its area is 3,157 square miles. The average width is 
about 70 miles, its area about two-thirds that of Pennsylvania, 



12 



S. D. RISLEY AND DR. R. G. CURTIN 



and four times that of Massachusetts. The general surface is 
mountainous; without a definite system, but composed of irregular 
ranges. In the west we have the Sierra de Chivigni range, entering 
Panama from Costa Rico, one peak being 11,265 ft., while Pico 
Blanco rises to 11,740. To the east of this range lies the Sierra 
de Veragua range, one peak of which rises to 9,275 ft. East of 
this irregular range lies the Sierra de Panama range, the highest 
peak of which rises to 1,600 ft. This range is broken at Culebra 











f^^^'^tg&s'' '?* -v 1* 




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■ ■'■■■» '-'''«.! ....... 



The great canal excavation at Culebra. 



Pass where the highest altitude falls to 345 ft, and is the lowest 
pass in the irregular mountain ranges in Central America, except 
that in Nicaragua, west of the Culebra. Pass, which is the only 
other feasible location for an interoceanic canal. 

East of the Culebra Pass the mountains again gradually 
increase in height culminating in an elevation of 3,000 ft. above 
the sea. The great rainfall of this region finds expression in the 
numerous rivers which drain its mountainous surface, 150 in all, 
50 of which empty into the Caribbean Sea and the remainder into 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 13 

the Pacific. Numerous islands and islets skirt both the Atlantic 
and Pacific Coasts of the Isthmus of Panama, 630 lying along the 
former and 1,053 on the latter side. Some of them are simply low 
reefs and are bare, others are covered with dense forests and 
groves of cocoanut palms. 

In regard to the topography of the Isthmus at the canal, 
General Abbot, of the United States Engineer Corps, says that 
nothing like a mountain chain, properly so called, is encountered 
on the line of the canal. Parts of the hills of the Isthmus were 
made by the action of volcanoes now extinct and portions are 
composed of sedimentary deposits. The rains and winds have 
worn down these elevations, so that the highest point on the line 
of the canal, at Culebra, was only three hundred and forty-five 
feet before the digging commenced. This is the great cut, and is 
about three-quarters of a mile long. 

From Colon to Gatun, five miles and a half, the canal runs 
through low swamps, filled with alluvial deposit, forming a dense 
jungle land, bordered by foot hills. From Gatun to Bohio, nine 
miles, it follows the Chagres River valley. At Bohio, the valley 
closes in, and above this, the plain of Tavernilla rises to form a 
junction with the Continental Divide at Obispo, seven miles from 
Bohio. At San Pablo, where the valley is again shut in, there is 
formed a constriction which is the scene of freshets. From Cule- 
bra, seven miles distant from Obispo, the route of the canal 
follows the Rio Grande down a gradual slope to La Boca, the 
Pacific terminus, a distance of eight miles. A vertical cross- 
section of the Isthmus on the line of the canal shows a very flat 
anticlinal arch with the apex at Culebra. 

Volcanic activity has long ceased near the Panama route, but 
occasional moderate earthquake shocks are felt near Panama, 
the echoes of remote violent disturbances. General Abbot gives 
a record of the earthquake shocks for five years in Panama and 
at San Jose, Costa Rico. At Panama, there were seven tremors, 
four slight shocks, and no strong shocks ; at Costa Rico, forty- 
three tremors, nine slight shocks, and thirty-five strong shocks. 

This relative frequency of seismic disturbance, showing, as has 
been frequently noted, that Nicaragua is situated within the vol- 
canic zone while the Isthmus of Panama is situated beyond and 
to the south of its border, a fact which is of signal importance in 
selecting a route for the interoceanic canal. If the Nicaragua 



14 



S. D. RISLEY AND DR. R. G. CURTIN 



route had been chosen the canal would have passed near Ometepa, 
which was in violent eruption in 1883, whereas, in the Panama 
route, the extensive atmospheric erosion of hills demonstrates that 
there has been no active volcanic eruptions for untold centuries. 

In one of the ruined churches in old Panama, at least two 
hundred years old, is shown an arch about fifty feet wide. It is 
the widest and flattest arch known to architecture, being almost 
horizontal. The story is told that a monkish architect was helped 
in building it by faith and prayer. He put it up a great many 
times, only to have it fall down. Finally, he spent a night in 




The Presidential Palace and home of President Amador, at Panama. 



fasting and prayer, telling God that it was for His glory and 
asking for help. He then put up the arch for the last time and 
demonstrated his unwavering faith by boldly standing under the 
arch while the supporting scaffolding was removed and it still 
remains where all else is in ruin. This arch proves that there 
have been no earthquakes of any account since it was built. 

The recent earthquake in Nicaragua and the eruption of 
Monatomba show the dangers of that region, sometimes called 
the "American Route," for the construction of an interoceanic 
canal. It is probably fortunate that the failure of the French 
companies and their willingness to turn their enterprise over to 
the United States for a stipulated sum of money led to the aban- 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 



15 



doiiment of Nicaragua as the site for the canal, since it lies in 
the earthquake belt. In December, 1904, a tremor occurred in 
Costa Rico, which lies north from Panama, but still south of the 
earthquake belt, which in conjunction with an unusually severe 
rain caused a landslide which either covered or carried down the 




The Canal Building in Panama, in which are centered all the offices of the various 
departments engaged in the engineering and sanitary work of the Commission. 



mountain side about twenty miles of the railroad between Porto 
Limon and San Jose, which interupted communication by rail for 
many months. 

While Panama is less prone to seismic influence, nevertheless, 
as the unexpected often happens, it might occur on the line of 
the canal. If a lock-canal, should be constructed with a large dam 
at Bohio, it is easy to see that the locks might be rendered useless 



16 



S. D. RISLEY AND DR. R. G. CURTIN 



for months, by a weakening, or destruction of the huge dam 
which would be required to retain the water. In deciding the 
form of construction, as between a tide level canal, or one with 
locks, it should be borne in mind that the immense body of water 
required to be held at a higher level, if suddenly released by the 
destruction of the dam, would flood a large area of country to 
the east, leading to the destruction of property and loss of life. 



TABLE I.— OBSERVED AIR TEMPERATURE ON THE ISTHMUS. 



Month 


00 

is 

as 

OS 


is 
3g 


e8 2 

.3 a 

!Jos 
<qeo 


- 00 

3| 

"OS 




GO 

o rt 

03 O 

© 


Mean 


January 


°c. 

26.25 
26.18 
26.47 
26.48 
26.73 
26.73 
26.77 
26.23 
26.57 
26.18 
26.10 
26.47 

26.43 


°c. 

24.10 
23.60 
24.15 
24.90 
26.85 
27.70 
26.75 
26.60 
27.15 
26.55 
26.80 
25.75 

25.91 


°c. 

24.96 
26.06 
26.55 
27.05 
25.55 
26.21 
26.02 
26.20 
25.97 
25.46 
25.60 
25.76 

25.95 


26.17 
26 25 
26.62 
27.25 
27.07 
26.69 

26.45 
26.01 

25.78 

26.48 


°c. 

26.20 
26.79 
27.25 
27.69 
27.01 
27.23 
26.69 
26.10 
26.46 
25.84 
25.79 
26.48 

26.63 


°C. 
26.60 
26.15 
26.33 
27.65 
27.90 
28.85 
28.31 
28 00 
27.94 
27.45 
26.80 
26.80 

27.40 


°C. 

25.71 
25 84 
26.23 
26.84 
26.85 
27.23 
26.91 
26.63 
26.82 
26.32 
26.18 
26.17 

26.48 


°F. 

78.28 


February 


78.51 


March 


79.21 


April 


80.31 


May 


80.33 


June 


81.01 


July 


80.44 


August 


79.93 


September 


80.28 


October 


79.38 




79.12 


December 


79.11 


Means 


79.66 







TABLE II. 





03 
03 

5 03 
O 2 

P<o3 


.2 

O 03 

M 03 
" 00 

Si 


Average temperature 


03 
U 

o 

03 

u 

M 
03 

3 


Localities 


a 
B 
< 


00 rt 
03^ 

■»* S 

° 2 
WS 


OS 


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o 

a 

03 
h 
Ov 

s 


Washington 


o 

39 
30 
25 
23 
23 
18 
18 
13 

4 
15 

9 


25 
25 
21 

10 
12 
10 
20 
1 
17 
26 


°F. 

54.7 
68.8 
77.5 
80.0 
76.8 
78.8 
78.1 
75.6 
79.7 
800 
79.7 


°F. 

76.9 

82.4 

84.4 

94.8 

82.4 

81.5 

81.1 

76.9 

82.0 

84.0 

81.0 


°F, 

33.2 

53.3 

70.5 

64.0 

70 3 

75.7 

74.6 

73.4 

77.1 

77.0 

78.3 


°F 

43.7 

29.1 

13.9 

30.8 

12.1 

5.8 

6.5 

3.5 

4.9 

7.0 

2.7 


°F 
104 




99 


Key West 




Assuan or Wadi Haifa 


119 


Habana 


101 


San Juan, P. R 


101 


Kingston, Jamaica 




Cayenne 




Manila 

Isthmus of Panama 


100 

99 







These tables are from 
Abbot. 



'Problems of the Panama Canal," by Brig. Gen. Henry L. 






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CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 17 

Temperature of the Isthmus. 

The temperature of the Isthmus, always the controlling factor 
in meterological and health conditions, while in some measure 
modified by the physical features of the region, as already 
described, is really controlled by the geographic position of the 
Isthmus in relation to the oceanic currents, the annually recurring 
solstices, and the trade winds. In point of fact, altitude is the 
least important factor in the meteorology of the region. The 
Isthmus of Panama is situated in about g° of north latitude. 
x\s a consequence the sun at noon is in the zenith twice annually, 
first on the 13th of April, when it crosses the line passing to the 
summer solstice. 

But as the sun passes northward, the gradual but progressive 
diminution of temperature which would naturally result is over- 
come by the steadily lengthening days and the consequent longer 
duration of solar radiation, so that the maximum temperature is, 
in fact, reached at the summer solstice in June, the reverse being 
true as the sun passes southward and crosses the 9th meridian on 
August 29th to its winter solstice in December. 

Notwithstanding this semi-annual march of the sun back and 
forth across the line the variation between maximum and mini- 
mum temperature is surprisingly small. For example, reference 
to Table 1 shows a mean monthly maximum temperature in June, 
1902, of 81.01, and a minimum of 78.28 in January of the same 
year. 

A study of extreme maximum daily temperature on the 
Isthmus shows that the recorded heat is never as high as at New 
Orleans, Havana, or Washington, D. C. Indeed, the marked 
characteristic of the climate of the Isthmus is its great uniformity. 

The actual results of the sun's radiation as recorded by the 
thermometer at different localities on the Isthmus and the extra- 
ordinary uniformity shown by the monthly observations, as set 
forth in the accompanying table are explicable only through the 
careful consideration of a number of modifying conditions. The 
most important of these are the oceanic currents and the direction 
of the prevailing winds. 

Influence of Oceanic Currents and Prevailing Winds. 

In any study of the climatology of the Isthmus the fact that 
the thermal equator, on the longitude of the Isthmus of Panama, 
does not coincide with the geographic equator of the globe but 



18 S. D. RISLEY AND DR. R. G. CURTIN 

lies to the north of it, approximately 8.50 or 9 , or, just to the 
south but very near the Isthmus of Panama ; the line of highest 
temperature, i. e., the thermal equator, being carried northward 
from the geographic equator by the great oceanic current which 
carries thither the heated equatorial waters of the Atlantic Ocean. 
These waters increase the temperature not only of the Isthmus 
of Panama but of the whole of Central America and of those 
portions of the United States which form the coast line of the 
Gulf of Mexico. That the temperature is uniformly high but 
never rises on the Isthmus of Panama to the extremes observed 
in many other localities is explained by the direction of the pre- 
vailing winds, which is controlled by the thermal equator, the 
semi-annual march of the sun, forward and backward between 
the tropics of Cancer and Capricorn, and by the rotation of the 
earth's surface eastward. 

The winds from the south flow inward to supply the vacuum 
created by the rising column of heated air as the sun passes north- 
ward of the thermal line, and the prevailing winds during that 
period, which corresponds to the rainy season, are southerly. As 
the sun passes to the south to its winter solstice, for the same 
reason the winds become northerly ; but, owing to the rotation of 
the earth the direction of the winds is diagonal to the Equator. 
Northeasterly winds, therefore, prevail during the dry season, 
from December to April, and southeasterly from April to Decem- 
ber, the wet season. 

It follows, therefore, the geographic trend of the Isthmus 
being east and west, that it is traversed through its long axis by 
these perpetual trade winds which are filled to the point of 
saturation by rapid evaporation from the heated waters of the 
Equator carried northward by the great ocean currents. 

As a consequence the Isthmus is constantly enveloped in a 
canopy of aqueous vapor, which regulates the temperature, by 
rendering latent the sun's energy by day, and by preventing 
radiation from the earth's surface during the night. The tempera- 
tures recorded are, therefore, never as high as in more arid 
regions and never fall as low ; these peculiar atmospheric condi- 
tions accounting for the extraordinarily equable mean monthly 
temperatures. 

Rainfall. 

These peculiar conditions, furthermore, explain the extraor- 
dinary rainfall of the Isthmus, while the direction of the winds 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 



19 



in relation to its geographic position account for the peculiarities 
of its distribution. It is obvious (from consulting Table 3) that 
but a slight fall in temperature is all that is needed to precipitate 
in rainfall the water contained in an atmosphere laden to the point 
of saturation. The annual rainfall is 140 inches at Bohio on the 
Atlantic side, where the land begins to rise for the Continental 
Divide, at Culebra, it being on the side whence come the pre- 
vailing winds, the actual precipitation in a single year having 
reached 200 inches; while in the interior it is 93 inches and on 
the Pacific side 60 inches. When we compare this rainfall with 
that of New Orleans, which is about 2.7 inches, and with Wash- 
ington, D. C, which is 24.10 inches, the great difference is appar- 
ent. A fact of signal, practical importance in the construction of 
the canal is the variation in the rainfall at different seasons of 
the year. For example, there is a well defined dry or so-called 
winter season extending through four months, from the middle 
of December to the middle of April, the following eight months 
constituting the rainy or summer season. 



TABLE m.-CONSOLIDATED RECORDS OF RAINFALL IN INCHES. 





Atlantic 


Interior Stations 


: 


Pacific Coasl 




Month 


a 


"o 







pq 


p 
's? 

< 




S 
OS 


ee 
e 



u 



3 



ft 
m 

'& 
O 

■f. 

03 


03 
u 


S3 

s 

SB 

a 

S3 

ft 


S3 
SB 
O 

*i 

H 


DO 

O 

OS 

® 
1— 1 


OS 



PQ 

S3 


No. of years 

January 

February 

March 


(33) 

4.0 

1.4 

1.6 

4.2 

12.1 

13.4 

16.7 

15.1 

12.6 

14.0 

20.9 

12.3 


(7) 

9.0 

1.8 

23 

5.3 

13 3 

12.6 

17.1 

192 

16.6 

18.0 

20.3 

10.6 


(4) 

1.3 

0.3 

0.7 

4.9 

117 

12.3 

14.7 

12.9 

11.8 

14.9 

16.1 

7.5 


(21) 

24 

0.7 

0.9 

3.5 

10,9 

9.6 

10 3 

12.7 

10.9 

13 1 

12.2 

7.0 


(3) 

3.3 

0.6 

1.2 

2.4 

11.6 

93 

13.3 

14.2 

13 5 

11.2 

10.4 

5.5 


(10) 

1.8 

0.4 

0.8 

2.7 

10 9 

117 

8.8 

9.8 

12.2 

10.5 

10.6 

9.1 


(5) 

0.9 

02 

0.3 

2.0 

12 

10.2 

7.6 

8.9 

91 

11.7 

11.3 

11.2 


(4) 
0.7 
0.7 
1.6 
2.8 
7.6 
7.9 
7.6 
6.8 
7.5 
9.5 

11.6 
28 


(7) 
0.5 
0.1 
04 
1.7 
4.8 
5.5 
43 
4.8 
7.4 
6.6 
6.3 
3.2 


(3) 
0.2 
00 
00 
0.8 
6.8 
8.2 
6.2 
7.1 
7.3 
7.3 
41 
6.6 


(5) 
2.1 
0.1 
1.9 


April 

May 


40 
9.2 


June 


7 1 


July 


9 5 


August 

September 


7.2 
6.7 


October 


9.9 


November 


10 1 


December 


5.6 






Year 


128.3 


1461 


109.1 


94.2 


96.4 


89.3 


85.3 


66.8 


455 


54 


73 4 







W^e arrived, January 2nd, in the midst of the dry season but 
it was not, however, so very dry, for we counted five showers 
on the day of our arrival and it rained every day while we were 
on the Isthmus. These showers were of short duration, however, 
falling from light, fleecy clouds and coming on quite unexpectedly. 



20 



S. D. RISLEY AND DR. R. G. CURTIN 



Humidity. 

A study of the relative humidity, during the dry and wet 
months, made at Colon by the Old Canal Co. (1881) and by the 
U. S. Weather Bureau (1898-99) shows 80 per cent for the four 
dry months, 87 per cent in six of the rainy months and 83 per cent 
in the intermediate months of December and May. The humidity 
is excesive, therefore, over the entire Isthmus, the actual amount 
of moisture in the air on the two coasts and in the interior follow- 
ing closely the amount of rainfall in these respective localities, 
the absolute humidity being actually less by night than by day. 




View from the doctors' quarters at Ancon Hospital. 

When we compare this relative humidity with that of Philadel- 
phia, which averages about 69 per cent, and Denver, Colorado, 
which is 40 per cent, we can then realize the great amount of 
moisture in the atmosphere on the Isthmus. 

Climate. 

It follows from these considerations that the climate of the 
Isthmus of Panama is essentially tropical but that in consequence 
of its geographic position, its topography and relation to the 
trade winds and ocean currents, it is in many respects peculiar, 
even when compared with the West Indies, for example. The 
great rainfall, the persistent and uniform high temperature and 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 21 

high percentage of humidity, especially in the relatively low belt 
of the canal zone, render it, not only an extremely undesirable 
place of residence, but explains many of the difficulties which 
are encountered in the construction of the canal. The perpetual 
summer gives ample time, while the humid air, the rapid decay 
of vegetable matter and the fertile, rain soaked earth furnish all 
the requirements for a rapid and riotous growth of all vegetable 
life. 

The highlands are covered with a dense growth of towering 
trees, their tops being bathed in sunlight, while their roots are 
in everlasting shade and are buried in an impenetrable tangle 
of shrubs and vines. The valleys are water courses which, when 
flooded by tropical rains, spread over the low lands amid the 
tangle of vegetable life, forming extended morasses. When the 
waters temporarily subside these swamps are left festering and 
fermenting in the hot sunshine and become the birthplace of 
herds of pestiferous insect life, and seething caldrons from which 
eminate noxious gases to poison the air. 

Dark as this picture seems at first sight to the casual visitor, 
a deeper penetration, and more careful study of all the conditions, 
serve to lighten the background and to show that life on the 
Isthmus of Panama is not necessarily nearly so hopeless as it 
seems to the stranger. It should be borne in mind that the pure 
air of the trade winds from the Caribbean which carry over the 
Isthmus the water which makes these conditions possible, at 
the same time neutralize in large measure the resulting noxious 
atmospheric influences. With these winds to aid, all else that is 
needed, indeed, to convert the Republic of Panama into a modern 
Garden of Eden is the application of sanitary science and the 
wisely applied industry of man, protected by an honest and stable 
government. At the present time there are many beautiful homes, 
surrounded by fertile plantations, situated on the hillsides in the 
more salubrious localities, cooled by the sweeping trade winds, 
which traverse their broad verandas. The travelling guest 
from the temperate zone, as he gazes from their elevation over 
the picturesque beauties of the tropical scene, and realizes that 
the glories of nature exhibited to his view are never interrupted 
by the winter's sleep, is charmed by the paradise-like surround- 
ings. The uncontrolled forces of nature have heretofore, how- 
ever, for the most part maintained the ascendancy and have not 
only vanquished and held in subjection the aborigines of Central 



22 



S. D. RISLEY AND DR. R. G. CURTIN 



America, but also the early adventurous European settlers and 
their descendants. By virtue of its peculiar geographic relation 
to the highways of commerce, it has been singularly subjected to 
danger from infection by all infected ports with which it was in 
communication, and in turn has become the distributing center 
for tropical diseases to the seaports of the world. From the 
time of the adventurous Buccaneers, to the present day, but 
especially since the construction of the Panama Railroad, the 
Isthmus of Panama has been the highway of commerce between 




Dead Man's Island, Panama Bay, where eighty officers and sailors of the U. S. S. 

Jamestown were buried in 1858, victims of yellow fever. Under the 

jurisdiction of the United States. 

the oceans but in especially close and frequent communication 
with all of the ports of South America, the West Indies and the 
southern ports of the United States and Mexico. It is, therefore, 
not only in constant danger from infection by yellow fever, 
plague, smallpox and other diseases, but becomes itself a menace 
to the commercial ports of the world. 

Health Conditions. 

Any historical study of the health conditions of this region 
presents an appalling picture. The decimating of the ranks of the 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 23 

early explorers and the Buccaneers by disease, has been repeated 
again and again in the experience of those who have ventured for 
any reason to exploit this narow neck of land between the oceans. 
Perhaps the most signal demonstration of the noxious character 
of its climate was afforded by the laying of the Panama Railroad 
from 1848 to 1855. It has been said that there was a dead coolie 
for every tie used in its construction. While it is doubtless true 
that the accounts of the deaths attending that enterprise have 
been greatly exaggerated, nevertheless, Mr. Tracy Robinson, a 
native of New York, who has lived at Colon for 40 years, told 
us that there had been 1,200 deaths out of a total of 6,000 men 
employed. He stated also that at the City of Colon there had 
never been a marked epidemic of yellow fever, a fact probably due 
to its having a population immune to that disease and that the 
easterly winds from the sea make of Colon a relatively salubrious 
locality. The experience of the consulates and other European 
officials located at Panama City has nevertheless been a sad one, 
as shown by the records kept in the Foreign Cemetery since 1826. 
Many of them with members of their families are buried there, 
victims for the most part of yellow fever. In one case, both 
husband and wife succumbed to the disease in a single week and 
their immediate successors speedily followed them to a grave in 
a foreign land. The Isthmus of Panama has indeed been styled 
"the grave of the European." 

As to the health of the Isthmus, up to the present time, we 
quote at length from General Abbot as follows : 

"The health question during construction is one of the impor- 
tant elements of the canal problem. While no one will claim 
that the climate of the Isthmus is salubrious, it is certain that 
much wild exaggeration has been circulated, in great part founded 
on the experience of ill-acclimated laborers engaged in excavating 
surface soil for the railroad or for the canal. 

"The health statistics during the construction of the Panama 
Railroad have never been made public, but are well known to have 
been appalling. At that date it was not understood that natives 
of the temperate regions cannot safely perform arduous manual 
labor under exposure to a tropical sun, and that dependence for 
such work must be placed upon the negroes of the West Indies. 
White men can supervise, but must not attempt more. Fortu- 
nately, the health records during the canal operations (and espe- 
cially those during the operations of the new company, which 



24 S. D. RISLEY AND DR. R. G. CURTIN 

should furnish the best guide in view of the great changes in the 
physical condition of the region) have been preserved, and are 
shown in Table 18, contributed by Dr. Lacroisade, for many years 
(since 1887) the medical director of the company hospital near 
Panama. He is thoroughly familiar with the Isthmian condi- 
tions, and the notes following the table are a translation from a 
letter written by him on March 9, 1902, and published in 




**"£% 



The Marine Barracks at Empire. 

The Medical News, vol. 80, p. 707, New York, 1902. His views 
on this important subject are entitled to the highest confidence. 
He attributes the marked improvement, shown in Table 18, to 
the better accommodations of the laborers, to better drainage, and 
especially to the fact that the excavations have reached a level 
below the poisonous emanations of decaying organic matter. 
The period of serious sickness incident to excavation in tropical 
regions has apparently already been passed at Panama. It is 
interesting to note that whereas the percentage of disease and of 










1 * 



J ; 



i - 



® 



.tw 



rW*. '%»'? 



* • 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 25 

mortality for general ailments have remained sensibly unchanged 
during these successive epochs, they have fallen enormously in 
the later years for disease due to the local climate. 

"1898. — Among the employees of the company there was no 
sickness of an epidemic character; the sanitary conditions were 
satisfactory. 

"On the Isthmus generally, a light epidemic of influenza pre- 
vailed during the months of January and February, but no yellow 
fever or other sickness of an epidemic form appeared. 

"1899. — Among the employees of the company there' was a 
single case of yellow fever, contracted at La Boca in November, 
by a Frenchman recently arrived and employed on the harbor 
works. He recovered. There was no other sickness of an 
epidemic form among the employees of the company, and the 
sanitary condition was satisfactory. 

"In the City of Panama, between May and the middle of 
December, there were about 139 cases of yellow fever. Its victims 
were chiefly foreign sailors, arriving in the bay, and Columbian 
soldiers from the interior. 

"In June and July a rather severe epidemic of influenza 
occurred. In September a short epidemic of measles caused some 
deaths. The City of Colon appeared to be proof against yellow 
fever. 

"1900. — Among the employees of the company a single case 
of yellow fever occurred, terminating in recovery, and there was 
no other sickness of an epidemic form. The sanitary condition 
was satisfactory, notwithstanding the rather high death rate 
caused by a larger number than usual of deaths from chronic 
diseases of a general type. 

"On the Isthmus, generally, yellow fever, which had disap- 
peared after the middle of December, returned in March. 
Between that date and September 10th, about 138 cases occurred 
in Panama, of which 128 were among the Columbian soldiers 
from the interior. There was no other sickness of an epidemic 
form. The City of Colon escaped yellow fever. 

"1901. — No epidemic appeared among the employees of the 
company, and the sanitary condition was very satisfactory. 

"On the Isthmus generally, yellow fever, of which no case had 
been reported since September 10, 1900, was again imported in 
January, 1901, b> a priest and a sister of charity coming from 
Buenaventura. It was communicated to a sister of the orphan 



26 S. D. RISLEY AND DR. R. G. CURTIN 

asylum of the Central Hospital, and then to the superior. The 
latter alone recovered. These four were the only cases in January, 
1 901 ; and since then up to the present month (March, 1902,) 
there has been no return of the disease. 

"In April, 1901, a serious epidemic of smallpox appeared in 
Panama and still continues. The employees of the company have 
suffered very little, a result which should be attributed to the 
numerous vaccinations which have been made. 

"The City of Colon appears always to have escaped these 
epidemics. 

"General Conclusions. — Considering the average figures for 
the last four years, I find that with a personnel of 2,275, the 
percentage of disease has been 29.65 ; and the mortality, 2.35 
per cent. These figures do not exceed those on large works in 
any country. 

"It should, however, be added that this personnel has been 
long on the Isthmus and is well acclimated; I may even say ex- 
tremely so, since 91 per cent of the total death rate is due to 
chronic organic diseases common to all countries, leaving only 
9 per cent of it chargeable to the diseases of the local climate. 

"The classified employees, which constitute about 8 per 
cent of the entire force, are represented in the total death rate 
by 5.70 per cent, while the laborers are represented by 94.30 per 
cent. The mortality in the latter class is therefore the greater. 

"Among the infectious diseases on the Isthmus, yellow fever 
is undoubtedly the most to be feared by unacclimated persons 
of the white race. During the two recent epidemics of yellow 
fever the first from May to December 15, 1899, and the second 
from March to September 10, 1900 — only two cases appeared 
among the personnel of the company. Both were French, one a 
workman on the wharf of La Boca, who had been only a few days 
in the country ; and the other the head nurse of the company's 
hospital, who had held this position for two years. To these 
should be added the superior or sisters of the hospital, attacked 
in January, 1901, after three or four months of residence, one 
of the four solitary cases of this month just mentioned. These 
three cases recovered. I attribute the last two cases to infection 
proceeding from the foreign hospital, which received a large num- 
ber of the 261 cases occurring in the different epidemics ; and 
which, by its too close proximity, is a menace to the hospital of the 
company. The latter offers satisfactory sanitary conditions. 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 27 

"I have mentioned in former reports the disappearance of 
yellow fever from the Isthmus, from the year 1892 to the year 
1897. This would lead to the belief that that disease is in no wise 
necessarily epidemic. In 1897, indeed, between the beginning 
of March and the beginning of August, there were about 70 cases, 
as well at Panama as on a portion of the line of the canal; but 
no case occurred at Colon. 

"I will remark that the City of Colon, which up to about the 
years 189 1-2, was a location than which nothing could be better 
for yellow fever — reputed more dangerous than the City of 
Panama — has since that time remained free from any infectious 
disease and has escaped the yellow fever epidemics of 1897, J ^99 
and 1900. This is evidently due to the sanitary works which have 
been executed, the filling up of the many little swamps and the 
cleaning of streets, which before were veritable sewers. By these 
improvements, the City of Colon has been considerably freed from 
the swarms of mosquitoes which rendered life insupportable. 

"Might not a like result be secured for the City of Panama 
(1) by a good supply of water; (2) by drains to conduct sewage 
to the sea, to which its situation and conformation are easily 
adapted; and (3) by watering the streets daily in the drv season, 
and by cleaning them daily throughout the entire year. Now they 
are in a repulsive condition of filth. These three improvements, 
which I consider fundamental and essential, are now wholly neg- 
lected. There should also be instituted an effective quarantine 
service for vessels arriving^ in the harbor, for beyond all doubt 
the epidemics of 1897, 1899, 1900, and a few cases which occurred 
in January, 190 1, were due to importations, in one instance from 
the Atlantic and in three instances from the Pacific. 

"I do not expect by these measures to remove completely from 
Panama its character as a terrain favorable for the propagation 
of yellow fever; but certainly, if thoroughly applied, they would 
exclude some epidemics and render a residence on the Isthmus 
less dangerous for unacclimated persons of the white race. 

"The important works executed from one end to the other of 
the line of the canal have also done much to improve the sanitary 
conditions on the Isthmus." 

The prevalent diseases of the Isthmus, are yellow fever, 
malaria in its violent forms, beri-beri, smallpox, measles and 
dysentery. A case of supposed bubonic plague died in Panama 
City in 1905 which caused a great scare because of the fruitful 



28 



S. D. RISLEY AND DR. R. G. CURTIN 



soil afforded by Panama for its rapid spread, under conditions 
which would menace the commercial ports of the world. The 
present population of Panama City, Colon and the canal zone 
is 39,684, but the time is at hand when the population of the 
Isthmus is being rapidly reinforced by non-immunes to yellow 
fever and other tropical diseases. It would be natural, therefore, 
to expect a higher percentage of disease and death. It is proba- 
ble, however, that yellow fever and malaria especially,, will abate 
under the strict quarantine regulations against South American 
and West Indian ports which is now being enforced, and the 
skillful and scientific sanitary measures conducted by the officers 
of the U. S. Army, for unquestionably the two great causes of 
disease, excepting malaria alone, on the Isthmus, if we excluded 
climatic conditions, are commerce and filth. 



TABLE III.— OFFICIAL HEALTH STATISTICS 


OF THE PANAMA CANAL 






Percentage of disease 


Percentage of mortality 




OTl 
=4—1 O 












Years 



5R ft 


2 CD 




ses of 
ope 








g 


.2W 


BQ-rj 

0) u 


OS 

■+=> 

O 




s3 
O 




P 


s~ 


H 


P 


P 


H 


Old company : 














1881 


928 


2102 


42 03 


63.04 


1.94 


4.74 


6.68 


1882 


1,910 


18.85 


47 64 


66.49 


3.21 


4.39 


6.60 


1883 


6,267 


23.24 


42.62 


65 86 


3.20 


4.46 


6.66 


1884 


17,615 


27.58 


36.95 


64.57 


2.58 


4 08 


6.66 


1885 


15,215 


11.93 


49.14 


61.07 


1.73 


3.79 


5.52 


1886 


14,935 


14.01 


4388 


57.89 


1.37 


3.43 


5.10 


1887 


16,217 


21.83 


39 25 


61.07 


3.22 


3.99 


6.21 


1888 


13,725 


12.17 


40.46 


52.63 


1.81 


2.54 


4.35 


Mean 


10,854 


18.83 


42.75 


62.58 


3.05 


3.92 


5.97 


Receiver : 
















1889 


1,826 














1890 


f! 800 

971 


r 












1891 















1892 


1 












1893 


1 












1894 


{ 












Mean 






49.68 






2.88 


New company: 












1895 


1,225 






49.95 


2.05 


0.89 


2.94 


1896 


3,715 
3,980 
3,400 






39.91 
51.85 


2.08 
1.99 


0.84 
1.00 


2.92 


1897 






2.99 


. 1898 


28.26 


13.65 


41.91 


1.76 


0.27 


2.03 


1899 


2,500 


19.76 


5.84 


25.60 


2.24 


0.12 


2 36 


1900 


2,000 


17.05 


8.50 


25.55 


3.00 


0.25 


3.25 


1901 


2,000 


18.60 


6.85 


25.45 


1.55 


0.20 


1.75 




2,703 


20.92 


8.71 


37.17 


2.10 


0.51 


2.61 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 



29 



Such back yards we had never before seen. They were filled 
with bottles and the refuse of the kitchen, the foliage of the rank 
vegetation, excrement, and dish water which had been accumulat- 
ing for many years. In one case coming under our notice such a 
compost heap was removed only far enough from the house to 
allow the door to be opened half way. 

Malaria is probaly not more common on the Isthmus than it 
is in some localities in the United States; but in Panama it is an 
all-year-round disease. In his report for the month of November, 




Steam shovel at work. 



1904, Dr. Gorgas states that at Bohio the blood of 44 school- 
children was examined, the malarial organism being found in 
29 cases. Six grains of quinine a day was given to each of these 
29 children for fourteen days, and their blood was then re- 
examined. The blood of but five was then found to give a positive 
reaction. 

In Dr. Gorgas' report of the 106 deaths that occurred in 
Panama City during the month of November, only 89 of which 
were attributable to the city, it is stated that the death rate had 
decreased 19 from the month of October, 1904. We were sur- 
prised to read that beri-beri had caused ten deaths — the greatest 



30 S. D. RISLEY AND DR. R. G. CURTIN 

number due to any one disease. Dr. Stern, of Panama City in- 
formed us that this disease is always quite prevalent there, and is 
the cause of many, if not most, of the deaths. Nine deaths are 
recorded as having been caused by colic, eight by tuberculosis, 
eight by fever, and seven by bronchitis. Only one death is attri- 
buted to dysentery. President Amador, who is a physician, and 
Dr. Stern, who has practiced many years at Panama, both in- 
formed us that dysentery has never been what might be called 
epidemic, although it is usually present in Panama City and on 
the Isthmus. We heard of but one case of smallpox during our 
stay on the Isthmus, and this was taken from a ship at Colon 
hailing from a South American port while we were in that city. 

Sanitation on the Isthmus. 

Yellow fever on the Isthmus is generally a very malignant 
disease. Dr. Nelson states that of forty-one cases admitted to the 
Charity Hospital in Panama City in 1880 not one recovered. The 
destruction of mosquitoes and preventing their propagation by 
proper drainage, etc., are the great safeguards against both the 
yellow fever and malaria. Dr. Gorgas and his faithful corps of 
assistants who are directing the sanitary work are fighting these 
diseases along the line laid down by the investigations of Doctors 
Read and Finley and their colleagues, and used so successfully 
by Dr. Gorgas, in Cuba, viz. : that the mosquito is the sole propa- 
gating cause. Cases are removed to the hospital at once ; are 
carefully protected by mosquito netting both in transit and after 
being placed in the hospital, and the houses from which they were 
taken are thoroughly cleansed and fumigated. Sanitation is, 
indeed, the great problem which confronts the authorities on the 
Isthmus. The work is Herculean in proportion, but if the doctors 
are given proper authority and opportunity, we feel sure that, 
while victory may be delayed, they will in the end succeed. At 
present the canal employees are panicky, especially the Americans, 
and are retained with difficulty. 

Some are homesick, others are frightened, but with improved 
health conditions, more opportunities for amusement, more com- 
fortable Quarters, and more inviting food and lower cost of living 
they will be more contented and many of the existing difficulties 
will disappear. 

The energetic work of the engineers in draining Colon and 
the line of the railroad and canal, under the direction of the 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 



31 



sanitary officers removes the rank growth of vegetation and the 
pools of stagnant water, thus preventing the propagation of 
mosquitoes while the new pure water supply of Panama City per- 
mits, not only the removal of rain barrels and other recptacles, 
now the sole source of supply, but admits of the thorough 
washing of the city. Colon and Panama are the two largest 
cities, and although not included in the Canal Zone are located 
within its limits. The United States has, however, control of 
both these cities so far as sanitary and quarantine regulations. 




Laborers' Barracks left by the French Company. 



water supply and drainage are concerned. In point of fact, 
the sanitary problems are much less intricate than were those 
at Havana, where Dr. Gorgas and his assistants so success- 
fully labored ; but we must remember that in Cuba there was 
a water supply piped to the city at the time that the U. S. Army 
took hold of the problem. There was also an attempt at a 
sewerage system, although this was inadequate. In Panama 
managed on that account. When the necessary changes — 
such as a rigid quarantine, a proper water supply, underground 
drainage, the removal of swamps and stagnant water, and the 
establishing of adequate hospital facilities — have been completed, 
the great menace to health at Panama will be almost entirely 
removed. Much work in the way of draining the swamps and 



32 



S. D. RISLEY AND DR. R. G. CURTIN 



the ditches containing stagnant water that are found along the 
railroad and around the towns has already been accomplished. 
The filthy back yards have been cleaned ; covered barrels for 
refuse have been furnished ; cisterns have been covered ; cesspools 
have been cleansed ; and water that has been standing two days 
has been properly oiled, to prevent the propagation of the 
mosquito. We were satisfied that the Sanitary Bureau is well 
managed and in most excellent hands. All that is wanted is to 
let the work go on without hindrance. Science will then assert 
itself, and Panama will be regenerated. Even after that, how- 
ever, there will be danger from the extensive commerce with 




Thatched huts of natives of Panama. A large part of the rural 
population lives in such habitations. 



the West Indies and with South America, wihich will always be 
liable to introduce tropical and contagious diseases from the 
Atlantic and Pacific Oceans. This danger will be incurred 
later on, when the unacclimated and non-immune population has 
been greatly increased, as it will be When the work on the canal 
is fully under way. 

To the visiting medical man the great canal hospital at 
Ancon, reared by the French at the enormous cost of $5,600,000, 
is a feature of great interest. While the hospital is commodious 
and the grounds elaborate and beautiful, these enormous figures 
nevertheless show how little the French owners got in return for 
their money. In this connection we were informed that the 



CD O 

as 

- g 



CD 



_2 




CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 



33 



hospital and ambulances at Colon cost $1,400,000, and the sana- 
torium on the Island at Toboga was reared at a cost of $465,000. 
The Ancon hospital is situated on a hillside just out of the 
City of Panama on a beautiful site overlooking the harbor and 
Bay of Panama. It is erected on the pavilion plan, about forty 
buildings in all, one story in height with ample windows, wide 
doors and tiled roofs. The entrance driveway is lined by rows 
on either side with magnificent royal palms, from sixty to seventy 




Part of the barracks at Empire. 

feet in height behind which are located officers' quarters, and the 
bacteriological laboratories, where experts are busily engaged in 
further and extensive investigations of the mosquito theory of 
yellow fever, malaria, etc., and the examination of the blood. 
The general appearance of the hospital grounds suggest a park 
and exhibit the highest art of the landscape gardener applied 
under the favoring conditions of the tropics. 

Strange to say, a supply of fresh water was neglected, so that 
rain water is used ; and there is no system of drainage, but these 
defects are soon to be remedied. Yellow fever patients, covered 
by mosquito netting are carried to the wards through the main 
entrance and in front of the doors of the officers' quarters; a 
fact which demonstrates the deep conviction these medical men 
entertain of the truth of their teaching regarding the propagation 
of this disease by mosquitoes. The patient is then carried to the 
yellow fever pavilion, the beds in which are surrounded by wire 



34 



S. D. RISLEY AND DR. R. G. CURTIN 



netting ten feet high, eight feet wide and twelve feet long. The 
nurses are all from the United States. The temperature at Ancon 
is cooler than in the city, the elevation being greater, and is 
therefore fanned by the breezes from the sea and mountains. 

The discomforts of life on the Isthmus are greatly enhanced 
by the insect life of the jungle and also by those which infest 
the highlands everywhere in infinite numbers and in great variety. 
On leaving the city one encounters the red bug which burrows 
under the skin and lays it eggs which produce an irritation felt 
nightly for several weeks even after leaving the tropics. 




Town of Toboga on Toboga Island. 

In addition to these are the grass louse, the chigre, the wood 
ticks, or garrapatas, and the flies. These insects, together with 
the mosquito, conspire to render one's nights miserable after a 
tramp through the woods or grass. 

The Island of Toboga belonging to the Republic of Panama is 
situated ten miles from the city, in the Pacific Ocean. It is the 
summer and health resort of the Isthmus ; many wealthy citizens 
having their summer residences there. The town of Toboga, 
located on the northern slope of the island and stretching down 
to the sandy beach, is a picturesque and beautiful resort, embow- 
ered in tropical trees. 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 35 

Before leaving the Isthmus we were given a Panama breakfast 
on board an excursion steamer while traversing the Bay of 
Panama and skirting the shores of this beautiful island, lying as 
it does in the Pacific Ocean. President Amador and his charming 
wife accompanied the party. The island is ten miles from 
Panama, is twelve miles in circumference. Its sides are abrupt, 
rising at one place to a height of 935 feet. It is a veritable garden 
spot, where are grown pineapples, bananas, and cocoanuts, said to 
be the best to be found in the world. It possesses many mineral 
springs of iron and magnesium. We were informed that the inhabi- 
tants of the island lose their teeth early, owing to the iron in the 
water. This seems to indicate that the water is markedly acid. 
The island has a colony of lepers, and the rest of the population 
are largely fruit-growers and cottagers. It is far enough away 
from the lowland of the coast to be free from mosquitoes and 
other swamp influences. Having an ocean, rather than a seaside 
climate, it forms a convenient place where malarial patients and 
hospital convalescents can be sent to recuperate. Malarial 
patients are quickly cured by a sojourn there; and persons with 
lung diseases are sent there from the whole Isthmus, in many 
cases with benefit. It is the health resort of the Isthmus. 

Colon is a town of over 5,000 inhabitants, situated on an 
island of coral formation. Its principal buildings are the 
Washington Hotel, Canal Hospital and an English Church 
reared and maintained by the Panama Railroad from funds 
contributed through the efforts of an English lady who, while 
visiting the Isthmus, recognized the great need of such an 
edifice. The City of Colon, although dirty, is not so indiscrib- 
ably filthy as it was six months ago. There is no under- 
ground drainage or pure water, the water that the people drink 
coming from cisterns connected with the roofs of the houses. 
These roofs are usually covered with vultures, birds not very 
unlike our Southern red-headed turkey-buzzard, but smaller, 
citiznes. The cisterns, we were told, are cleaned out about once 
in every two years, when one or two inches of solid sediment is 
usually found and removed ; but a successful business man of 
Colon informed me that his cisterns had not been cleansed for 
ten years. He said, however, that the water was pure and con- 
tained no "wiggle-waggles" (meaning larvse). We then sug- 
gested that the water might be too deadly to support life. 

Colon is near the mouth of the Chagres River, which, we are 



36 S. D. RISLEY AND DR. R. G. CURTIN 

convinced, is not the deadly stream that it was once supposed to 
be. It is true that it is very malarious ; but unacclimated persons 
that have for six months lived along its banks do not, as yet, seem 
to have been influenced by it. A supposed healthful outing for 
the citizens of Colon is to go to Gatun and float down in canoes 
to the mouth of the Chagres River, a distance of about seven 
miles. 

We were told that the Isthmus is occasionally visited by mild 
cold spells, called "northers," during which, with a cloudy sky, 
a damp northwest wind blows for two or three days. This is 
followed by a fall of temperature in the daytime to about JQ° . 
This so-called coldness lasts for about one day. There are some- 
times storms, and even cyclones, in the middle of the rainy season. 
We were informed that the rainy months are also the malarial 
period, but that the disease is not wholly confined to that season. 

It will be seen from the foregoing statements and official 
reports that there is but little justification for the current exag- 
gerated stories told by homesick laborers, disgruntled adventur- 
ers, frightened travellers and bombastic literary heroes. 

To show what tales are told now, even on the Isthmus, 
when we landed at Colon we were informed that there had been 
ten cases of yellow fever in that city, that there were then 
twenty-four cases of the disease in the hospital at Panama City. 
We were assured by the medical officers in charge, however, that 
there nad been but ten cases in all at Panama City since the 
United States took charge of the Canal Zone. On our return 
to Colon, while waiting for the steamer, a gentleman wfao did 
not know that we were physicians, informed us that the Pan- 
American Medical Congress riad broken up in a panic because 
of the great prevalence of yellow fever, which was not true. 

Among the homesick and frightened Americans that have 
lately gone to the Isthmus the wildest stories are circulated ; and 
these are not only credited by them while there, but repeated after 
reaching the United States. The statistics of the United States 
marines stationed at Empire, on Culebra Hill, show that, up to 
the time of our visit, there had not been a single death from local 
diseases among the four hundred marines ; and that the per- 
centage of those in the hospital was not larger than would be 
found at the average post in the United States. It must, however, 
be borne in mind, that these soldiers live at one of the most 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 37 

salubrious spots on the Isthmus, are restricted to their camp, and 
compelled to live regular lives. 

In Dr. Gorgas's report of the 106 deaths that occurred in 
Panama City during the month of November, only 89 of which 
were attributed to the city, it is stated that the death-rate had 
decreased 19 from the month of October, 1904. We were sur- 
prised to read that beri-beri had caused ten deaths — the greatest 
number due to any one disease. Dr. Stern, of Panama City, 
informed us that this disease is always quite prevalent there, and 
is the cause of many, if not most, of the deaths. Nine deaths are 
recorded as having been caused by colic, eight by tuberculosis, 
eight by fever, and seven by bronchitis. Only one death is attrib- 
uted to dysentery. President Amador, who is a physician, and 
Dr. Stern, who has practised many years at Panama, both in- 
formed us that dysentery had never been what might be called 
epidemic, although it is usually present in Panama City and on the 
Isthmus. We heard of but one case of smallpox during our stay 
on the Isthmus, and this was taken from a ship at Colon while we 
were in that city. 

The importance of simple and prudent living in Panama, as 
in all tropical countries, cannot be too strongly stated. The 
following rules were laid down for the government of persons 
living in the tropics and which have been largely followed by 
the educated natives : ( 1 ) A quiet, regular life without the use 
of alcoholic stimulants. (2) Rise early, bathe, and take coffee 
and rolls. (3) Breakfast at 11 a. m., on ripe fruits, coffee, 
beefsteak or chops and potatoes. (4) Avoid the sun and active 
exercise as far as possible at midday. (5) Dinner at about 6 p. m., 
simple in character. (6) An evening without fatigue or dissipa- 
tion, and the avoidance by ladies of decollete dressing. (7) Retire 
early and sleep under mosquito bars. (8) Take four grains of 
quinine 'daily upon retiring. The observance of these rules is 
especially important to all strangers and unacclimated persons, 
since it gives strength to resist disease. Had they been carefully 
and persistently observed many lives would have been saved.. 
Dr. Nelson in his work recommends teetotalism as a safeguard. 
He states moreover, "Keep out of the tropics if you can ; should 
necessity force you_ within them, avoid all forms of alcohol, that 
you may spend your later days in peace and comfort." 

We were repeatedly told that many of the canal employees 
needlessly sacrificed themselves by leading profligate and licen- 



38 S. D. RISLEY AND DR. R. G. CURTIN 

tious lives, drinking intoxicants, gambling late into the night, 
thereby diminishing their power of resisting disease. 

The above rules for living are especially important to laborers. 
The laborers resident in the tropics know well from experience 
the wisdom of avoiding the midday heat and therefore quit work 
in the middle of the day. Then, too, it should be borne in mind 
that the heat experienced by these laborers is greater than that 
indicated by the observations recorded in the tables, where the 
thermometrical readings are taken in the shade with all glare 
excluded, whereas the laborer is exposed to the direct rays of 
the sun reinforced by the reflected rays, where the temperature is 
many degrees higher. Many are in the excavations, entirely cut 
off from all breezes ; but, strange to say, sunstroke and heat 
exhaustion are rare among the workmen. 

To the climatologist it is of interest to consider the logical 
influence of such a climate as we have described over the habits 
and character of the natives, since man is in some measure the 
creature of his environment. The dweller in Panama never expe- 
riences the invigorating cool breezes of more northern climes, but 
is constantly subjected to the continuous, moist tropical heat, 
which causes depression and lassitude. This, together with the 
ease with which their bodily wants can be supplied, tends to make 
of them an indolent, unambitious people. In a word they have 
no winter season against the rigors of which they must provide, 
in advance, a supply of food, fuel and clothing. In the north 
temperate zone, the marked changes of seasons, — seed-time, 
harvest and the long, frigid winter, — determine the habits and 
regulate the life of the people. Their recurring needs lead to fore- 
thought and frugality. Fruition is contingent upon endeavor. 
In the Republic of Panama nature has done her utmost. Per- 
petual summer means continuous fruitage and harvest. Every- 
thing is provided to meet the actual physical necessities 6f man- 
kind. In the north, hunger, gaunt of form and forbidding, stalks 
grimly beside the ploughman, dwells in the cabin of indolence and 
poverty, and sits at the loom of compelling industry. In Panama, 
hunger has been forever banished, since beneficent nature has cast 
her richest benefactions even into the lap of indolence. The lazy 
dweller under the warm, humid air eats and lies down to sleep; 
awakens and stretches forth the hand to pluck and eat again. The 
banana and orange ; the bread fruit and yam ; the khaki and the 
custard apple, together with many other wholesome and nutritious 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 39 

foods grow in wild profusion at the very door of the shack in 
which he lives and drowsily dreams away the centuries. 

Such an environment can but have an enervating and delete- 
rious influence over the physical, mental and moral nature of 
mankind. It is doubtless true that very much that is otherwise 
inexplicable in the political history and in some features of the 
social life of equatorial regions may find their reson d'tre in the 
climatic conditions which have been described. 

In conversation with a prominent clergyman, a graduate of a 
famous English university and a resident of Panama for thirteen 
years, he made the statement that about 86 per cent of his parish- 
ioners, composed of a native mongrel population were living out 
of wedlock, but that as a rule they were faithful to their mating. 
Dr. Nelson, in his book, "Five Years in Panama," confirms this 
state of affairs and gives as a reason for it, that the native women, 
knowing the vagrant character of their mates, realize that they 
can be held more certainly by simple mating, since in wedlock 
the union would prove a serfdom from which they could not so 
readily escape in the event of the husband proving unfaithful or 
brutal. This is a social condition probably without parallel in 
the temperate zone. 

It is inconceivable that any satisfactory and enduring form of 
government, having as its basis just trial by jury and an incor- 
ruptible judiciary, could ever grow out of such a soil or be reared 
and maintained upon a social substratum born in such a morass. 
If it is indeed true that the unstable conditions which our govern- 
ment found in existence in the Canal Zone and contiguous regions, 
were the result in some measure of the influence of climatic condi- 
tions over the life and character of the residents there, then it is 
obviously wise that the first endeavor should be to • remove or 
modify as far as possible the depressing influences of the region 
not only over the physical health of the people, but to provide for 
the elevation of their social condition. 

Pan-American Medical Congress. 

The Congress has become largely a Spanish-American body. 
The first meeting, held in Washington, D. C, in 1893, na< ^ between 
one and two thousand delegates. Since that time, covering a 
period of twelve years, it has met in Spanish speaking countries 
and the number of delegates in attendance has progressively 
decreased, until at the Panama meeting there were approximately 



40 S. D. RISLEY AND DR. R. G. CURTIN 

but one hundred present, forty of whom were from the United 
States, twenty-two of them ariving at the close of the Congress, 
having been delayed en route by the slowness of their vessel. 

More and more of the papers presented are in Spanish, a fact 
which makes the Congress less attractive to the English speaking 
delegates and, we think unfortuately, the next, the fifth, Congress 
is to be held in Guatemala, Central America. As will be seen 
from the foregoing, the interest is rapidly waning in all parts of 
America, since, although the meetings have been held for the 
past twelve years in tropical countries they have not been largely 
attended by members of the profession resident there. 

We think that it is important for the future success of the 
Pan-American Congress that it should meet at least alternately 
in the North, either at Washington, in some Canadian city or at 
New Orleans, in order to maintain the interest of the English 
speaking delegates. The only general discussion in English 
awakened in the Congress was on yellow fever, its etiology and 
sanitation. A paper on the subject by Dr. Finley was read by 
Dr. Emilio Martinez of Havana. The paper was a strong presen- 
tation of the theory which claims that the mosquito is the sole 
factor in the propagation of the disease and was discussed at 
great length by Drs. Gorgas, Carter and others. Some of the 
participants, while accepting the mosquito as an important factor 
in the spread of yellow fever, were not willing to accept it as 
the sole agent in the propagation of the disease. 

The social features of the Congress left nothing to be desired. 
The visiting members were most hospitably and elaborately enter- 
tained, receiving during their stay on the Isthmus nothing but 
kindness and courtesy at the hands of the entertainment com- 
mittee, the U. S. Sanitary officials, the government of the 
Republic of Panama, the medical practitioners and the citizens 
generally. We are particularly indebted to Dr. Gorgas, who 
introduced us to the chief official in the Bureau of Statistics, 
who very kindly placed at our disposal elaborate statictics on 
climate, health, disease, etc., collected . under his supervision by 
the French Canal Commission, and aided us in our search 
through them for the data we desired. 

At the close of the Congress we returned to Colon to await 
the sailing of the homeward bound steamer. While there we had 
an opportunity to witness the practical application of one of the 
methods of the Sanitary Bureau. Two hours before sailing, after 



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CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 41 




Public wash house, Port Limon; stalls rented to washerwomen. 




it n —hi .ninpnTTixn - ~*~-~~" 

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Zent River, Costa Rica. Terminus of the railroad. 



42 



S. D. RISLEY AND DR. R. G. CURTIN 



our luggage had been packed but before it was removed from 
the rooms we had occupied, men came with pans and brooms and 
burned a regulation quantity of pyrethrum powder in the closed 
apartments and then carefully shook out the mosquito bars and 
bedding, swept the floors and burned the sweepings. The motive 
was to destroy any mosquito which might have feasted upon us, 
as we had so recently come from the infected City of Panama. 

At 7.30 p. m v January 10th, we began our homeward journey 
on the Preston, one of the extensive fleet of the United Fruit 




Zent River, Costa Rica. 



Company, but sailing under the flag of Sweden. Indeed, we saw 
no ship in those waters bearing the Stars and Stripes except the 
ships of our navy. At 2 p. m. on the nth, after a tempestuous 
voyage, we reached Port Limon, Costa Rica, where we remained 
until 3 p. m., January 14th, while the ship was taking her cargo 
of bananas for New Orleans. The three days delay, however, 
proved a most delightful experience. Port Limon is a well kept, 
clean city, with an abundant and pure water supply, secured 
through the able and rigid management of the United Fruit 
Company. We had the opportunity to visit the large and commo- 
dious new hospital located there and reared by the Fruit Company, 



CLIMATOLOGY, DISEASES AND SANITARY CONDITIONS 43 

where every facility has been secured for the isolation and treat- 
ment of yellow fever and malarial patients, or those afflicted by 
other forms of disease. While in Costa Rica we were the guests 
of the Fruit Company, who entertained us hospitably. An inter- 
esting and instructive experience was an excursion by rail to their 
extensive banana plantations on the picturesque and beautiful 
Zent River, twenty-nine miles inland from Port Limon, where 
they gave us an elaborate breakfast. Their plantations there 
cover an area of thirteen miles square. A trip by rail to the City 
of San Jose, called the Paris of Central America, was to have 
been an interesting part of our pilgrimage, but was rendered 
impossible by an extensive landslide which had carried approxi- 
mately twenty miles of the railroad from the mountain side into 
the vallev below. 



BIBLIOGRAPHY. 

"Problems of the Panama Canal," by Brig. Gen'l. Henry L. 

Abbot, U. S. A., 1905. 
"Five Years at Panama." Dr. Wolford Nelson, 1889. 
"Report of Sanitary Conditions at Panama," by Col. W. C. 

Gorgas, U. S. A. 



MAY 21 1906 



LIBRARY OF CONGRESS 



021 064 023 A 



